New to this Forum-with Ollie a Cushings Dog, False Positive Cushings

[Squirt's Mom]

Check out these links from our Helpful Resource section:

This first link gives general information on Vetoryl (Trilostane) and the original method of testing:
http://www.k9cushings.com/forum/show...-and-Resources

There is now a new testing protocol in EU that vets in the USA are just learning about. That info is here. Feel free to share with Olli's vet.
http://www.k9cushings.com/forum/show...l-(trilostane)

[Harley PoMMom]

Dechra, the makers of Vetoryl, state that the ACTH stimulation test should be performed 4-6 hours after the Vetoryl has been given with a meal. Some veterinarians are now administering the ACTH stimulation test (for monitoring purposes) in shorter times. Dr. Mark Peterson, who is a renown veterinarian that specializes in endocrinology, recommends doing the test 3-4 hours post pill, here's an excerpt from his blog:

With trilostane, it’s extremely important to give the morning medication with food, and then start the ACTH stimulation test 3 to 4 hours later.

https://endocrinevet.blogspot.com/20...-for-acth.html

The important thing is to do the test at the same time frame so as to be consistent, so if the vet does the test 4-6 hours after the Vetoryl/Trilostane was given than it should always be done in that time frame if possible.

Lori

[alleng8304]

Ollie my 9yr old, Terrier has diabetes and Cushings. He weighs 15 ibs. His diabetes is under control @ 4 units q12 of Vetsulin . His bld glucose now runs between 60-100 most times and always under 200. On Friday, 7/27 he had a ACTH stim. His results were 0.9 and 0.7. Reference range 1-5- Trilostane dose of 5 mg. The 0.9 and 0.7 numbers tell me his adrenals are NOT working and vet suggested to stop Trilostane for one week and then restart @ 1.25 mg. q12. I am concerned that if he gets stressed we could go into a full blown Addison's. He is also partially blind from the diabetes but still seems to get around OK. We were going to have cataracts removed, but now will have to wait awhile. The vets seems to think that his adrenals will bounce back?? Any thoughts and Thank you. It has been a long battle with these two diseases.

[labblab]

Welcome back, Allen! You’ll see I’ve merged your new question about Ollie into your original thread. This way, we’ll have his complete history consolidated all in one place. Your vets are correct in saying that cortisol levels will rebound in most dogs subsequent to temporary discontinuation of the trilostane. However, our experience here is that the time period can be highly variable. Some dogs quickly begin making excessive amounts of cortisol, while the effects of adrenal oversuppression can linger for others. For a few dogs, adrenal function remains permanently suppressed.

I realize you’ve been working hard to coordinate both the insulin and trilostane doses for Ollie. Therefore, you have added pressure not to leave him off the trilostane any longer than is necessary. But I personally wouldn’t feel comfortable restarting it so quickly in the absence of repeating the cortisol testing in some form. If not a complete ACTH, then at least a resting cortisol level. As is, restarting in a week at that specific lowered dose seems like a shot in the dark to me. As I say, I’d want some concrete evidence that Ollie’s adrenal function has sufficiently normalized before resuming the medication.

Marianne

[alleng8304]

Marianne-

Thank you and I agree. Without knowing if the Adrenals are functioning I will not restart the Trilostane. I think that a month may be a more reasonable time period. To do another ACTH stim @ $232 in one week seems like a waste of money. I understand the reason for moving the post to the older threads so it gives complete info. But I am a little concerned that the this last post may not be seen since there are so many. But you saw it? It has been a long hard road in the last 6 mo with Ollie

[Squirt's Mom]

All your posts are being seen...we just may not have anything to offer other than "I see your post" so we don't comment. Keeping all info in one place helps not only the staff and members but also you. This tread will serve as a sort of diary or journal for the Cushing's journey. You can come here anytime and look back to see if there is a pattern, to remind yourself of when events happened or tests were given, etc. But rest assured, your posts are seen even when no comment is offered.

Hugs
Leslie

[alleng8304]

Marianne-
In speaking to the vet further this afternoon, Ollie's resting cortisol would be the first Number which was 0.9-close to normal but when down to 0.7 (suppression). He is getting a protocol from Merck and I will share it with the group. Thanks. We agreed to watch sugar levels and not repeat ACTH for several weeks with Ollie off Trilosane.

[labblab]

Yes, before restarting, you would probably want to see a resting cortisol back up to around 2.0 or higher if you were to try to rely on that alone. However, in a situation like this, it’s always better to perform a full ACTH to make sure that sufficient cortisol reserves are available. And per Dechra, the manufacturer of brandname Vetoryl, this is what you’d be looking for:

If the ACTH stimulation test is < 1.45 μg/dL (< 40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and ACTH stimulation test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

https://www.dechra-us.com/Admin/Publ...ack-insert.pdf

Marianne

[alleng8304]

many thanks

[alleng8304]

Ollie-9yro diabetic and Cushings- not new to this forum. We stopped his Trilostane 5 mg daily (7/31) since his last ACTH stim was terrible-0.9 resting and 0.7 rebound. His glucose levels were staying in the 60-120 range but now going up. Last night- 1hr after evening meal and 4 u of insulin-bld glucose was 236. This morning 1 hr after meal and 4 u-his bld glucose was 231.

Does this make sense-His need for insulin will be greater with Ollie off Trilostane and sugar will go up. Vet seems to think that we should leave his insulin dose as is for now and I will recheck blood later today when insulin peaks. I also believe that his Adrenals are not burned out since his glucose went up. I think the plan should be to do a resting Cortisol next week and if in normal range- start back on Trilostane at very low dose-perhaps 2.5 mg. Any thoughts. Thank you!